Getting a doctor appointment may become increasingly difficult for seniors and the disabled over the next decade unless Congress changes the new health law, according to a report that the conservative National Center for Policy Analysis plans to release today. Due to scheduled "draconian" changes in payments to doctors and hospitals serving Medicare beneficiaries, the NCPA says, seniors may soon face the same access issues that sometimes send poor Medicaid recipients to community health centers and safety net hospitals.

Thomas Saving, director of the Private Enterprise Research Center at Texas A&M University, was a public Medicare trustee until 2007, and authored the report. By the end of this decade, Medicare will pay physicians and hospitals less than Medicaid does, Saving forecasts. Already, Medicaid pays medical providers only about 80 percent of what private insurers pay, and Medicare will fall significantly below that, Saving reports.

Of course, Saving's findings assume that Congress will do nothing to block scheduled payment cuts to physicians, although Congress has regularly headed off the reductions in recent years, with the support of both Democrats and Republicans. Indeed, the new health care law also took for granted that the physician cuts will take place, and therefore was able to count those reductions as savings to the Medicare program.